Cost-Related Nonadherence in the Medicare Program

Kennedy, James J.; Maciejewski, Matthew L.; Liu, Darren; Blodgett, Elizabeth

doi:10.1097/mlr.0b013e318210443d

Cited by 32 publications

(36 citation statements)

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13] The introduction of the Part D program led to higher medication use rates among seniors, with recent studies indicating that other healthcare service use reductions partly offset program costs. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Most Part D enrollees' expenditures do not reach the gap threshold: 12 % of enrollees, and 19 % of those who filled at least one prescription, reached the gap in 2009, lower proportions than in previous years. 29,30 Still, enrollees who reach the gap are more likely to discontinue or reduce medication use.…”

Section: Introductionmentioning

confidence: 96%

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

et al. 2013

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BACKGROUND:Although the Medicare Part D coverage gap phase-out should reduce cost-related nonadherence (CRN) among seniors with diabetes, preferential generic prescribing may have already decreased CRN, while smaller numbers of patients using more costly branded oral antidiabetic (OAD) medications remain vulnerable to CRN. OBJECTIVE: To estimate the effects of cost sharing in the Part D standard (non-LIS) benefit on adherence to different OAD classes, comparing two classes dominated by inexpensive generic medications and two by more costly branded medications. DESIGN AND PATIENTS: Retrospective cohort study using dispensed prescription data for elderly non-LIS (N= 81,047) and LIS (low-income subsidy) (N=150,359) beneficiaries using same class OAD(s) in 2008 and 2009. Logistic regression modeled non-LIS likelihood; LIS and non-LIS patients matched using propensity outcome (N= 38,054). Logistic regression, controlling for demographic and health status characteristics, modeled effects of non-LIS coverage on 2009 OAD class adherence. MAIN MEASURES: Main outcome measures were within-class OAD coverage year adherence, with patients considered adherent when days supplied to calendar days ratio at least 0.8. KEY RESULTS: Non-LIS patients had 0.52 and 0.57 times the odds of branded-only DPP-4 Inhibitor (N= 1,812; 95 % CI: 0.43, 0.63; P<0.001) and Thiazolidinedione (TZD) (N=6,290; 95 % CI: 0.52, 0.63; P<0.001) adherence. Most patients (N=32,510; 82 %) used OADs in primarily generic classes, where we found no significant (Biguanides; N=21,377) or small differences (Sulfonylureas/Glinides [N=19,240; OR: 0.91; 95 % CI: 0.86, 0.97; P =0.002]) in adherence odds. Crude adherence rates were sub-optimal when CRN was not a factor (Non-LIS/LIS: Biguanides: 65 %/65 %; Sulfonylureas/Glinides: 66 %/ 68 %; LIS: DPP-4 Inhibitors: 66 %; TZDs: 67 %). CONCLUSIONS: Gap elimination would not affect generic, but should reduce branded OAD CRN. Branded copayments may continue to lead to CRN. Policy initiatives and benefit changes targeting both cost deterrents for patients with more complex disease and non-cost generic OAD underuse are recommended.

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Section: Introductionmentioning

confidence: 96%

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

et al. 2013

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“…4 Employing prescription drug cost-saving strategies are an important mechanism to help patients reduce their OOP drug cost burden. Though physicians may consider drug costs when determining effective therapy, they face the barriers of insufficient time, discomfort with the topic, lack of available cost information, and insufficient knowledge of solutions when considering addressing cost with their patients.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…If health care teams are able to help patients afford their prescription drugs and adhere to therapy, the full benefit of improved health outcomes may be realized. 3,4 Limitations There are 2 important limitations to this study. First, long-term follow-up data were not collected; as a result, it is unknown whether learners retained changes in knowledge and attitudes over time; if any prescription drug cost-saving strategies were used on behalf of patients; and whether the application of such strategies reduced patients' OOP drug costs.…”

Section: Change In Proportion Of Positive Response To Behavioral Quesmentioning

confidence: 99%

“…6 Even if the provider is aware of the prescription costs, the skill of helping patients manage OOP prescription drug costs is not consistently taught in health professional educational programs and is not routinely addressed during patient encounters. 4,[7][8][9][10][11][12][13][14][15] While a more informed, cost-conscious health care workforce is one step toward improvement in patient adherence with prescription drug therapy, recent health policy legislation is changing the way the health care workforce engages patients. Medical institutions have attempted to keep pace so that future health care providers are prepared and can effectively adapt to the evolving changes in health policy.…”

Section: Setting Intervention and Participantsmentioning

confidence: 99%

“…1,2 Despite efforts to improve access to needed prescription drugs, cost-related nonadherence to prescription drug therapy remains an important public health problem, as it may result in poor clinical outcomes and increased costs. [2][3][4] Physicians and other prescribers may not be aware of high drug costs for specific patients, have time to address those costs in patient visits, or have an efficient manner in which to address high drug costs for their patients. Physicians may not be familiar with, or have easy access to, an individual patient's formulary and extent of OOP drug costs.…”

Section: Setting Intervention and Participantsmentioning

confidence: 99%

See 2 more Smart Citations

Pharmacy Students Teaching Prescribers Strategies to Lower Prescription Drug Costs for Underserved Patients

Stebbins¹,

Frear²,

Cutler³

et al. 2013

JMCP

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BACKGROUND: The rising costs of health care and, in particular, prescription drugs remains a challenge. Health professionals' ability to promote cost-effective prescription drug use is critical, yet this subject is not included consistently in the curriculum of most health professional schools. As experts in prescription drug selection, use, and cost, pharmacists are in a unique position to help manage prescription drug regimens for the best therapeutic outcome, while also helping to keep patients' out-of-pocket (OOP) prescription drug costs low. In addition to promoting interprofessional collaboration, pharmacy student-led lectures may provide an effective means to teach prescription drug cost-savings strategies to other health professional students and current prescribers.

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Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D

et al. 2015

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IMPORTANCE Understanding factors that lead to nonadherence to glaucoma treatment is important to diminish glaucoma-related disability. OBJECTIVES To determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma and to evaluate associated risk factors for such nonadherence. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional study using 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims. Coding to extract data started in January 2014 and analyses were performed between September and November of 2014. Participants were all Medicare beneficiaries, including those with a glaucoma-related diagnosis in the year prior to the collection of the survey data, those with a nonglaucomatous ophthalmic diagnosis in the year prior to the collection of the survey data, and those without a recent eye care professional claim. INTERVENTION Effect of the implementation of the Medicare Part D drug benefit. MAIN OUTCOMES AND MEASURES The change in cost-related nonadherence and the change in cost-reduction strategies. RESULTS Between 2004 and 2009, the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% (P < .001) and 2.8%, respectively (P = .001). However, reports of failure to obtain prescriptions owing to cost did not improve in the same period (3.4% in 2004 and 2.1% in 2009; P = .12). After Part D, patients with glaucoma had a decrease in several cost-reduction strategies, namely price shopping (26.2%-15.2%; P < .001), purchasing outside the United States (6.9%-1.3%; P < .001), and spending less money to save for medications (8.0% to 3.5%; P < .001). Using a multivariate analysis, the main independent risk factors common to all cost-related nonadherence measures were female sex, younger age, lower income (<$30 000), self-reported visual disability, and a smaller Lawton index. CONCLUSIONS AND RELEVANCE After the implementation of Part D, there was a decrease in the rate that beneficiaries with glaucoma reported engaging in cost-saving measures. Although there was a decline in the rate of several cost-related nonadherence behaviors, patients reporting failure to fill prescriptions owing to cost remained stable. This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical therapy prioritization, particularly in certain high-risk sociodemographic groups.

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Cost-Related Nonadherence in the Medicare Program

Abstract: Part D coverage reduced but did not eliminate CRN for newly insured beneficiaries. Unresolved CRN persisted for newly insured and continuously uninsured beneficiaries, particularly among disabled beneficiaries.

Cited by 32 publications

References 0 publications

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

Pharmacy Students Teaching Prescribers Strategies to Lower Prescription Drug Costs for Underserved Patients

Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D

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